الملخص
Objective:To explore the relationship between constitutional types of Chinese medicine and Alzheimer's disease (AD) and to construct an early warning model for AD risk.Methods:In the established multimodal interventions to delay dementia and disability in rural China (MIND-China) study, 4 033 elderly subjects aged ≥60 years old were included. The data including demographic, underlying disease and neuropsychological data were collected.The Chinese medicine service record form for the elderly was used to assess constitutional types of Chinese medicine and to apply the NIA-AA diagnostic criteria published by the National Institute on Aging and the Alzheimer's Association in 2011 for the diagnosis of clinically likely AD. Logistic regression analysis and AD risk prediction models were constructed using R statistical software, and the final prediction results were presented using columnar plots.Results:The MIND-China cohort was dominated by the abnormal constitution (69.28%), of which Phlegm-wetness type was the most common (58.05%), followed by Yang-deficiency type (23.85%). The most constitutional type of Chinese medicine among AD patients was Phlegm-wetness type (54.35%), followed by Qi-depression type (38.04%). Multi-factorial logistic regression analysis suggested that increasing age ( β=0.101, P<0.001, OR=1.107, 95% CI=1.069-1.146) and Qi-depression type ( β=0.622, P=0.016, OR=1.862, 95% CI=1.116-3.076) were able to increase the risk of developing AD, while education ( β=-1.047, P<0.001, OR=0.351, 95% CI=0.205-0.584) was able to reduce the risk of developing AD. By using the risk score model to calculate the total risk score for each subject and plotting the receiver operating characteristic curve (ROC), the area under the ROC was 0.769 and the calibration curve showed excellent consistency between prediction and reality. Conclusion:Older adults with Qi-depression type are significantly associated with an increased likelihood of AD.
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Objective:To evaluate the clinical efficacy and safety of compound glycyrrhizin combined with tripterygium wilfordii polyglycosides for psoriasis.Methods:Literature search was conducted in CNKI, Wanfang, VIP databases, Sinomed, PubMed, the Cochrane Library and Embase with the deadline of September 28th, 2020. The randomly controlled trials of compound glycyrrhizin combined with tripterygium wilfordii polyglycosides in treating psoriasis was included. The publication bias and methodology quality of RCTs were evaluated according to the Cochrane 5.0.1 bias risk assessment method. The RevMan 5.3 software was used for meta analysis.Results:Ten studies with 961 patients were included, with the experimental group ( n=486) and the control group ( n=475). The results of meta-analysis showed that the total effective rate [ OR=3.16, 95% CI (2.00-4.99), P<0.001], the cure rate [ OR=2.56, 95% CI (1.94-3.61), P<0.001], the recurrence rate [ OR=0.15, 95% CI (0.04-0.60), P=0.007], the total incidence of adverse reactions [ OR=0.53, 95% CI (0.34-0.82), P=0.004], the incidence of abnormal liver function [ OR=0.17, 95% CI (0.06-0.47), P=0.001] in the experimental group were better than those in the control group. There was no significant difference on the incidence of adverse reactions of digestive tract ( P>0.05) or lower extremity or facial edema ( P>0.05) between both groups. Conclusions:Compound glycyrrhizin combined with tripterygium wilfordii polyglycosides is effective in the treatment of psoriasis than tripterygium wilfordii polyglycosides alone, and can reduce the recurrence rate and the incidence of adverse reactions. However, a large number of large samples and high-quality studies are still needed.
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Objective To discuss the clinical relevant factors of air enema reduction in children with intussusception. Methods The clinical data of 1 223 children with intussusception from January to October 2017 were reviewed retrospectively. The clinical features of air enema reduction failure were analyzed. Results Among the 1 223 children with intussusception, 1 140 children achieved successful reduction by air enema, and 83 children were failed. The reduction rate was 93.2% (1 140/1 223). Among the 83 failed children, 64 cases had bloody stools, 5 cases had no defecation since onset, and 51 cases were depression and lethargy. The course of disease was 6 h to 5 d. The ileocolonic intussusceptions was in 51 cases, ileo-ileo-colon intussusceptions in 15 cases, ileum-ileum intussusceptions in 6 cases, ileo-ileo-colonic-colonic intussusceptions in 3 cases, and ileum-cecum intussusceptions in 8 cases. Among the 51 ileocolonic intussusceptions children, there were 2 cases whose nested head located in the sigmoid, 6 cases in the liver area, 23 cases in the middle of the transverse colon, 15 cases in the middle of the ascending colon, and 5 cases in the ileocecal junction. The length of the intussusceptions was more than 5 cm, with 5 to 10 cm in 51 cases, 11 to 20 cm in 27 cases, and 21 to 30 cm in 5 cases. The diameter of nested head was 4 to 8 cm, with an average of 5 cm. The failed air enema children were treated with operation. Two cases of intestinal duplication, 13 cases of Meckel diverticulum, 2 cases of juvenile polyp, 2 cases of Peutz-Jeghers syndrome were found during operation. Conclusions There has low successful rate of air enema reduction in the children with long duration, much older, poor whole body condition and complex or secondary intussusception. Correct judgment of surgical indications could increase the successful rate of air enema reduction.
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OBJECTIVE:To systematically review the efficacy and safety of intrathecal injection of vancomycin combined with dexamethasone in the treatment of intracranial infection,and to provide evidence-based reference in the clinic. METHODS:Re-trieved from PubMed,Medline,CJFD,VIP,Wanfang databases,randomized controlled trials(RCTs)about intrathecal injection of vancomycin combined with dexamethasone in the treatment of intracranial infection were collected. Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies according to Cochrane system review manual 5.0.1. Then Meta-analysis was conducted by Rev Man 5.2 statistical software. RESULTS:Total of 8 RCTs were included,involv-ing 543 patients. Meta-analysis showed that,compared with intravenous dripping of ceftriaxone or vancomycin,intrathecal injec-tion of vancomycin combined with dexamethasone could significantly increase response rate [RR=1.18,95%CI(1.11,1.26),P<0.001] and bacterial clearance rate of CSF[RR=1.13,95%CI(1.01,1.27),P<0.001] of intracranial infection patients,shortened treatment time [SMD=-1.60,95%CI(-1.89,-1.30),P<0.001],reduce the incidence of ADR [RR=0.48,95%CI(0.32,0.73), P<0.001]. At the same time,it also could improve changes of intracranial pressure[SMD=-1.78,95% CI(-2.10,-1.47),P<0.001],changes of protein quantitation of CSF[SMD=-0.18,95%CI(-0.25,-0.11),P<0.001] and changes of glucose quantita-tion of CSF[SMD=1.77,95%CI(0.91,2.63),P<0.001],with statistical significance. CONCLUSIONS:Intrathecal injection of van-comycin combined with dexamethasone shows good clinical efficacy for intracranial infection,improves bacterial clearance rate, shortens treatment duration,significantly lowers intracranial pressure and protein quantitation,improves glucose quantitation of cere-brospinal fluid,with good safety.
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OBJECTIVE:To compare the cost-effectiveness of cefazolin sodium pentahydrate versus cefazolin sodium in treat-ment of bacterial infection,and to provide reference for rational drug use in the clinic.METHODS:In retrospective study,207 bac-terial infection patients receiving cefazolin sodium pentahydrate or cefazolin sodium were selected from our hospital during Nov. 2014 to Dec. 2015,including 109 cases in cefazolin sodium pentahydrate group and 98 cases in cefazolin sodium group. Both groups received relevant medicine 2 g,bid,ivgtt,within 7 d. The clinical efficacies,bacteriological efficacies and safety of 2 groups were compared,and pharmacoeconomics of 2 therapy plans were evaluated.RESULTS:The clinical response rates of cefazo-lin sodium pentahydrate group and cefazolin sodium group were 89.91% and 74.49%,with statistical significance(P<0.05);bac-terial clearance rates were 76.32% and 72.13%,with no statistical significance(P>0.05). No drug-related ADR occurred in 2 groups during the treatment. Total shot-term(7 d)cost of cefazolin sodium pentahydrate group and cefazolin sodium group respec-tively were 4 391.43 yuan and 3 396.19 yuan. Using clinical response rate as effect index,cost-effectiveness ratio of them were 48.84 and 45.59,and incremental cost-effectiveness ratio was 64.55,which was lower than per capita GDP of Hengshui city. The sensitivity analysis results were in agreement with the cost-effectiveness analysis. CONCLUSIONS:Under the current economic sit-uation of Hengshui city,cefazolin sodium pentahydrate has cost-effectiveness advantage in the treatment of bacterial infection than cefazolin sodium.
الملخص
OBJECTIVE:To compare the cost-effectiveness of cefazolin sodium pentahydrate versus cefazolin sodium in treat-ment of bacterial infection,and to provide reference for rational drug use in the clinic.METHODS:In retrospective study,207 bac-terial infection patients receiving cefazolin sodium pentahydrate or cefazolin sodium were selected from our hospital during Nov. 2014 to Dec. 2015,including 109 cases in cefazolin sodium pentahydrate group and 98 cases in cefazolin sodium group. Both groups received relevant medicine 2 g,bid,ivgtt,within 7 d. The clinical efficacies,bacteriological efficacies and safety of 2 groups were compared,and pharmacoeconomics of 2 therapy plans were evaluated.RESULTS:The clinical response rates of cefazo-lin sodium pentahydrate group and cefazolin sodium group were 89.91% and 74.49%,with statistical significance(P<0.05);bac-terial clearance rates were 76.32% and 72.13%,with no statistical significance(P>0.05). No drug-related ADR occurred in 2 groups during the treatment. Total shot-term(7 d)cost of cefazolin sodium pentahydrate group and cefazolin sodium group respec-tively were 4 391.43 yuan and 3 396.19 yuan. Using clinical response rate as effect index,cost-effectiveness ratio of them were 48.84 and 45.59,and incremental cost-effectiveness ratio was 64.55,which was lower than per capita GDP of Hengshui city. The sensitivity analysis results were in agreement with the cost-effectiveness analysis. CONCLUSIONS:Under the current economic sit-uation of Hengshui city,cefazolin sodium pentahydrate has cost-effectiveness advantage in the treatment of bacterial infection than cefazolin sodium.
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Objective To explore the interventional treatment method for complex and refractory lymphatic malformation in children.Methods The clinical data of 78 cases with complex and refractory lymphatic malformation during January 2013 to January 2016 in our department were retrospectively analyzed.The lesions involved the neck in 28 cases,maxillofacial regions in 19 cases,the chest and armpit in 8 cases,the limb in 7 cases,the pelvic cavity and retroperitoneal space in 6 cases,the superior mediastinum in 3 cases,the hypogloeeis in 3 cases and scrotum or perineum region in 4 cases.All the children underwent ultrasound or MRI imaging studies preoperatively.The interventional procedures included:(1) Percutaneous puncture of the LM for sclerotherapy.The lesions were punctured with 20 G needle under the guidance of DSA or ultrasound and the correct positions were confirmed with angiography.The liquid of the lesions was extracted as far as possible.The dosage of sclerosing agents was adjusted according to the size of lesion.The dose of Laurolacrogol injection was 1/10—1/5 of the amount of the liquid in the lesions and the maximum of Laurolacrogol foam was ≤8 ml(20 mg).The dose of Pingyangmycin was ≤ 8 mg.(2) The drainage catheter placement and sclerotherapy.Percutaneous catheter drainage under ultrasound guidance or by surgery was conducted.The liquid in the lesions was drained by retaining the catheter for 1-4 weeks,and sclerotherapy was applied for several sessions during this period.(3) Treatment for one time a week,2 times a session.The interval of every two sessions was 4 weeks.The sclerosing agents included:Laurolacrogol Injection or Pingyangmycin for the lesions with high tension,Laurolacrogol foam for the lesions with low tension,Pingyangmycin for the microcystic lesions.Statistical analysis was conducted using SPSS20.0 software.Results A total of 208 sessions of sclerotherapy for 78 LM patients were performed and average session was (3.0±0.8).Nine patients used Lauromacrogol foam,23 patients used Lauromacrogol Injection,39 patients used pingyangmycin,while combined treatment was conducted in 7 patients.Laurolacrogol injection was used in 20 cases,Pingyangmycin in 29 cases and combination therapy in 5 cases for the high tension lesions in the neck,maxillofacial,chest and armpit.The low tension lesions of pelvic cavity and retroperitoneal space in 6 cases and of superior mediastinum in 3 cases were placed with draining catheters,and treated with sclerotherapy with Laurolacrogol foam.Three cases with hypogloeeis LM was neonates,who were treated with Laurolacrogol injection.The lesions on the limb and scrotum or perineum region were almost microcystic,were treated with Pingyangmycin in 9 cases and with combination therapy in 2 cases.The total curative rate was 97.4％ (76/78),total effective rate was 100％ (78/78).Imaging examinations showed that the cavities were closed or only a small amount of residual sclerotic lesions were present.Clinical examinations showed that the surface masses almost disappeared.The follow up period was 6 months to 2 years.There were no serious complication and adverse reactions occurred.Conclusions Interventional treatment is a safe,effective,and minimally invasive treatment for the complex and refractory lymphatic malformation.In order to receive the best treatment effect,we should use targeted therapy for different region and type of LM.
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The paper described the periodic progress of public hospitals reform in Anhui province,and analyzed the difficulties encountered,proposing measures and recommendations.These include reasonable adjustment of medicine prices for betterment of public hospital compensation mechanism; toplevel design in supportive measures of county-level public hospital reform; breakthrough of existing personnel system to ease shortage of medical staff in primary institutions; encouragement of diversified investment in medical sector to invite private resources into public hospital reform.
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Objective To explore the therapic effect of the combination of endovascular embolization and clinical hormone in treatment of Kasabach-Merritt phenomenon (KMP),and analyze the advantages.Methods Six cases with KMP from May 2010 to June 2012 were retrospectively analyzed.All the patients underwent large dose hormone shock therapy after admission for 7-10 d.Subsequently,selective endovascular embolization was performed using Seldinger technique under general anesthesia Then,the hormone therapy was continued for 2 weeks after embolization.The platelet count and the effect were recorded.If the area of the tumor reduction is less than 50％,3-4 courses of local hardening treatment was conducted for the residual tumor.The local treatment used multipoint puncturing of the tumor and injection drugs under X-ray fluoroscopic monitoring until the tension of local vascular increased.Results On DSA,the lesions of all the 6 cases showed rich blood supply with a large number of hybrid distribution of tumor blood vessels.The lesions disappeared in 4 cases after 1-2 weeks combination therapy and no recurrence for 0.5-1.0 year follow-up.Two cases whose tumor reduced less than 50％ after combination therapy received local hardening treatment,and faded after 3-4 courses.The number of platelet for all patients kept normal and the spirit of the patients showed great improvement,the bleeding tendency and local soft tissue swelling was in remission.Subcutaneous blood stasis and petechiae disappeared.There were no serious adverse reaction and complications.Conclusion Combination therapy with endovascular embolization and clinical hormone for Kasabach-Merritt phenomenon has a good curative effect.